Breast Reconstruction Pathways

For many women, breast reconstruction after mastectomy is a process that happens in steps. One of the most common approaches is called expander implant reconstruction. It uses a temporary device called a tissue expander to slowly create space for a permanent breast implant.

Step One: Placing the Tissue Expander

During your mastectomy (or sometimes in a separate surgery), your surgeon places a tissue expander under your chest muscle or remaining breast skin.

• What it looks like: A tissue expander is a soft, balloon-like device with a small valve that allows your doctor to add fluid later.

• Why it’s used: After a mastectomy, there isn’t always enough skin or muscle to immediately fit an implant. The expander gradually stretches this area in a controlled, safe way.

• Timing: Some women have the expander placed at the same time as mastectomy (“immediate reconstruction”), while others may wait until after treatments like chemotherapy or radiation (“delayed reconstruction”).

Step Two: Gradual Expansion

After surgery, once you’ve had some time to heal, your doctor will start the expansion process.

• How it’s done: At each office visit (usually every 1–2 weeks), your surgeon adds a small amount of sterile saline (salt water) through the expander’s hidden valve. This takes just a few minutes.

• What you might feel: Some women describe temporary tightness, fullness, or pressure in the chest after an expansion. This usually eases within a day or two.

• How long it takes: The process continues until the expander has stretched the skin and muscle enough to fit your desired implant size. This can take a few weeks to a few months, depending on your body and goals.

Step Three: Placing the Implant

Once your chest area has expanded enough:

• Second surgery: The expander is removed and replaced with a permanent breast implant (saline or silicone). This surgery is usually shorter and easier to recover from than the mastectomy.

• Final results: The implant restores the shape and contour of the breast. Some women also choose additional procedures to adjust the opposite breast for symmetry.

Why Women Choose This Option

Expander implant reconstruction is one of the most widely used methods because:

• It’s less complex than flap (tissue-based) surgeries, which borrow skin and fat from other areas of the body.

• It avoids additional scars on the abdomen, back, or thighs.

• It offers flexibility—you and your doctor can gradually decide what size feels right during the expansion process.

• The recovery time after implant placement is often shorter compared to flap procedures.

Things to Keep in Mind

Every reconstruction choice comes with considerations:

• It involves two or more surgeries (expander placement and implant exchange).

• Radiation treatment can sometimes affect how expanders and implants heal or look.

• Implants don’t last forever—you may need replacement or revision surgery in the future.

• The reconstructed breast will look different from a natural breast—it may feel firmer, cooler, or move differently.

• Some women experience rippling or capsular contracture (scar tissue tightening around the implant), though not everyone does.

A Personal Journey

Choosing expander implant reconstruction is a deeply personal decision. For some women, it feels like the right balance of recovery, appearance, and simplicity. For others, different reconstruction options—or no reconstruction at all—are a better fit.

Your body, your choice, your timeline. Expander implant reconstruction is just one path toward feeling whole again after breast cancer—and the right choice is always the one that feels right for you.